This application proposes a training plan to develop Steven L. Mansberger, M.D., M.P.H. into an independent clinician/scientist specializing in ophthalmic epidemiology and biostatistics. Dr. Mansberger is a board certified ophthalmologist with subspecialty training in glaucoma. He has prior research experience involving screening for glaucoma, the relationship between optic disc pathology and visual function, and ocular blood flow. Devers Eye Institute, Oregon Health Science University, and the Northwest Portland Area Indian Health Board have extensive experience with research and education and are especially well suited as training sites. This training program will consist of advanced coursework in biostatistics and epidemiology, multi-disciplinary conferences, and mentored research. Mentored research will be conducted under the direction of a mentorship committee composed of Thomas Becker, M.D., Ph.D., Interim Chairman of the Department of Public Health and Preventive Medicine at OHSU, Chris Johnson, Ph.D., Director of Diagnostic Research at Discoveries In Sight/Devers Eye Institute, and Francine Romero, Ph.D., M.P.H., Principal Investigator of the Northwest Tribal Health Research Center Project. George A. Cioffi, M.D., Anne L. Coleman, M.D., Ph.D., and Dongseok Choi, Ph.D. will serve as consultants on the project as committee members. Most epidemiological studies have used expert personnel, such as ophthalmologists or optometrists, to diagnose eye diseases as part of a prevalence survey. However, newer methods of evaluating the visual field, retina, and optic nerve make it possible for non-MD, non-OD paraprofessionals (such as ophthalmic technicians) to perform a baseline examination and refer participants with abnormal results for a definitive exam by expert personnel. This staged protocol allows persons to be examined rapidly and with reduced expense. The specific aims of the research project are: 1) to determine if non-MD, non-OD paraprofessionals (such as ophthalmic technicians) performing newer methods of testing have good diagnostic precision and feasibility in comparison to an expert examiner; 2) to attain preliminary data regarding the age-specific prevalence of visual impairment, blindness, and ocular disease in a sample of Northwest American Indians and Alaskan Natives (AI/AN) aged 40 years and older. This project will then lead to a larger, more comprehensive survey of the prevalence and causes of visual impairment in AI/AN.